Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patient’s healthcare experience, both in and out of the doctors office. Founded in August, 2019, we are obsessed with eliminating wasteful friction patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved, so that patients and doctors can focus on health, rather than payment or administrative hassles.
The LPN Reviewer position is a crucial role in our organization as business needs change quickly — in this role you are responsible for performing a full range of activities that will positively impact the organization and contribute to guiding the strategic operations for the company.
As an LPN Reviewer, you will help us accelerate our culture through interactions with our customers. In this position, as an LPN Reviewer, you will perform prospective reviews (prior authorization) and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. You will work closely with Medical Directors and other Cohere Health staff to ensure appropriate cost-effective care by applying your clinical knowledge and critical thinking skills to assess the medical necessity of therapy and procedure requests. You will be required to review Commercial, Medicare, and Medicaid lines of business.
What will you do
- Perform clinical reviews of therapy (speech, occupational and physical) and pain management procedures utilizing health care provider submitted information and National review guidelines
- Provide exemplary customer service with every interaction
- Collect and gather all necessary information for clinical review
- You will be cross-trained with other various positions within the company
- Must have a strong sense of self-awareness, willingness to learn and accept coaching to improve
- Must have empathy of others and ability to build rapport
- Thrive in a fast-paced environment, and are willing to jump in and help other team members
- Interact with providers via inbound calls, outbound calls, emails, and other communication platforms
- All other duties as assigned
- Strong communication skills, able to take unstructured information and structure it
- Ability to work cross functionally across remote teams
- Familiarity with Prior Authorization processes in healthcare
- Kind, Patient and Caring in even the most stressful situations
- Thrive in a fast paced, self-directed environment
- Intellectual curiosity with a strong desire to understand a problem and work it to a viable solution
- Ability to navigate and use multiple systems to compile needed information in a timely manner
- Skilled in problem solving and delivering quality results.
- Demonstrates ability to de-escalate escalated calls.
- Excellent interpersonal skills, oral and written communication skills
- Ability to meet established performance targets for quality and volume completed on an hourly, daily, weekly, monthly basis
- Flexibility and agility, works well in ambiguous situations, clear understanding of an early stage startup environment
- Experience in a Production environment
- LPN licensure in state of residence is required
- Healthcare experience is required
- Proficient in medical terminology
- Proficient in use of computers in daily function
- Preferred proficient in using a Mac
- Must have excellent computer skills, with a strong understanding of most major applications including GSuite products and Microsoft products
- Excellent communication skills both written and oral
- Passionate about continuous process improvement, always actively seeking out practical solutions to challenging business problems
- You understand that this position is very fluid and the term “not my job” doesn’t exist
- Associates degree preferred
- Must be able to pass background check
Important to know about this role:
- We’re looking for west coast LPNs, or LPNs that can work 11-8pm EST (8-5pm PST, 9-6 MST, 10-7 CST)
- This is a 100% remote role, and requires robust internet speeds (above 50 megabytes/second), including the ability to utilize zoom meeting software and to stream video
- We strongly believe in pay equity and transparency and as such would like to share that our hourly rate of pay for this position is $18.75 and an annual bonus.
We can’t wait to learn more about you and meet you at Cohere Health!
Equal Opportunity Statement
Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it’s personal